CMS Hospital Star Ratings Offer Incremental Step Forward in Transparency

Would you consult a Michelin Guide if you were looking for the closest pizza place? No. But for people who are seeking a “once in a lifetime” dining experience on their special vacation, finding the right 3-star Michelin restaurant may be just what they want.

Michelin has a storied history and promotes their strict system for evaluating restaurants via their publishing & promotional efforts. Still, most consumers who are not familiar with Michelin’s methodology would probably guess that a 3-star rating isn’t so wonderful, compared to 4 and 5-star ratings doled out by so many other restaurant reviewers.[1]

My point is: when it comes to ratings, it is critical to know what universe is being rated and the methodology used to calculate the ratings.

On that score, the CMS Quality Star Ratings for hospitals offer an incremental step forward in improving the value of the Hospital Compare data to consumers. If nothing else, the Quality Star Ratings generate attention, which can lead to further research that uncovers richer information on which to base decisions.

Value of Ratings

Ratings and rankings of products and services will always be imperfect. So, why are ratings so popular? In part, because they fill an information gap for data that either aren’t available or aren’t easy to summarize because of their complexity. In essence, ratings are a signal of comparative quality and often a proxy for missing data.

Measuring and comparing quality among healthcare provider organizations presents an especially thorny problem as described by Andy Oram in a 2-part series on measuring quality[2].  One pertinent extract from part 2 for which I provided some input:

We are still searching for measures that we can rely on to prove quality–and as I have already indicated, there may be too many different “qualities” to find ironclad measures. McCallum offers the optimistic view that the US is just beginning to collect the outcomes data that will hopefully give us robust quality measures.

CMS Hospital Quality Star Ratings

What is the overall objective of the CMS Star ratings? In essence, the star ratings serve to condense the information in the Hospital Compare database and improve the usefulness of that data by making it faster and easier for consumers to assess quality of hospitals in a comparable manner. The hospital star ratings also complement other Star Rating initiatives from CMS that cover nursing homes, dialysis facilities, home health care ratings and health plan finder ratings.

The composite star rating for hospitals is based on 7 quality categories:

1. Mortality	22%
2. Safety of Care	22%
3. Readmission	22%
4. Patient Experience	22%
5. Effectiveness of Care	4%
6. Timeliness of Care	4%
7. Efficient Use of Medical Imaging	4%

Categories were chosen to align with CMS Hospital Value-Based Purchasing (HBVP) program. The right-hand column lists the weights that were assigned each category in calculating the composite rating. Note, the methodology document describes how the weightings were calculated in more detail and should be consulted by those who really want to dig into the details. (See the Fact Sheet from CMS for a description of the ratings and a link to the methodology report: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-07-27.html).

The composite ratings and the underlying measures remain limited to values that are currently measured by HEDIS, HCAHPS surveys and other quality initiatives. As I mentioned in Andy Oram’s article, measuring outcomes in a meaningful and comparable way is still in early stage. In the future, clinical outcomes measures will improve and the ability to measure “effectiveness of care”, for instance, will improve and that category will likely be weighted more heavily (it is currently weighted at only 4% of the composite rating).

Limitations of CMS Ratings = Opportunities for Data Publishers

Back in 2011, after a lively presentation by then US CTO Todd Park (all of his presentations are lively!) on the topic of Data Liberación, I wrote:

Park spent some time describing Healthcare.gov and HealthData.gov and how they can act as a resource for entrepreneurs. I loved his analogy between HealthData.gov and NOAA data. He told an anecdote of how someone once told him that NOAA is unnecessary because one can find the same data in a more user-friendly application on Weather.com.  What the commenter didn’t realize is that NOAA data form the backbone of Weather.com. The federal government provides the data gathering, normalizing, and updating functions and then makes the data available to others who can overlay, combine, segment, analyze, integrate and distribute the data in any variety of mashed-up and improved formats.

The tradition of building data businesses on the foundation of federal, state, and local government data is strong. Savvy data publishing entrepreneurs have been digging deeply into government sources of data and providing new applications based on the data for centuries and new data products and services continue to emerge.[3]

The door remains open to enterprising data companies that are willing to do the hard work of aggregating and integrating data from multiple sources and presenting the aggregated data clearly for consumers. In most cases, a single source of information isn’t sufficient to guide consumer decisions. Proximity and referrals will remain key determinants of choice of hospitals for consumers.  Furthermore, choice is restricted by whether providers are included a patient’s health plan network.

So, from my perspective, the new CMS Hospital Quality Star Ratings represent a step forward in the supply of source data and ratings methodologies that healthcare data publishers can leverage to publish and promote value-added quality guides and other transparency tools for healthcare consumers.

To close, I’ll quote the final paragraph from Oram’s article:

When organizations claim to use quality measures for accountable care, ratings, or other purposes, they should have their eyes open about the validity of the validation measures, and how applicable they are. Better data collection and analysis over time should allow more refined and useful quality measures. We can celebrate each advance in the choices we have for measures and their meanings.

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[1] Priceonomics recently posted a good article on the Michelin Guides: http://priceonomics.com/why-does-a-tire-company-publish-the-michelin-guide/.  Accessed 8/2/2016.

[2] Part II of Oram’s 2-part series focuses on assessing and measuring healthcare quality: http://www.emrandehr.com/2016/02/10/what-is-quality-in-health-care-part-2-of-2/, accessed 8/2/16.

[3] Leveraging the Liberated Data, Health Content Advisors blog, http://www.healthcontentadvisors.com/blog/2011/9/25/leveraging-the-liberated-data.html. Accessed 8/2/16.

How Avvo is Connecting Patients and Doctors via Content

[Update: Avvo has sold its healthcare business to HealthTap as of November 29, 2012 to focus on its legal business.

In the business-to-business (B2B) sector, InfoCommerce Group[1] has been the leading consulting firm that has helped guide traditional directory publishers to transform themselves into online marketplaces that connect buyers and sellers. As my colleague Russell Perkins wrote last week, “Until quite recently, the gold standard was buying guides … that provided buyers with little more than a starting point’.[2]

The same holds true with physician directories-in print and online. Directories of medical professionals that follow the old-model compilations of profiles based on basic descriptive data–including specialty, education, board certifications, which insurance they accept, whether there are any complaints of misconduct–have represented the status quo for some time. The biggest differentiator between most of the competing doctor rating sites has been the availability and quality of user ratings.

Avvo = Blog Network + Doctor Profiles + Ratings 

Avvo, a young company in Seattle that has had success in the legal market, has just expanded into the healthcare market with a new approach to online physician directories.[3] Avvo has done the groundwork of compiling profile and related data from state and national medical boards and insurance company websites for 800,000 doctors, which is essential as a starting point in today’s competitive doctor ratings environment. But Avvo goes further and combines the model of existing doctor ratings sites and physician blog networks.

Content Marketing 

I especially like their use of content as a tool for attracting and engaging consumers. With Avvo, the content is contributed by the doctors who are profiled. Doctors can contribute health information by publishing health guides or by responding to questions submitted by consumers. Because the location of the person asking the question is listed, local doctors have an added incentive to respond to questions by local consumers. At this point in their development, there isn’t too much doctor-contributed content on which to rate the quality or likely success of this “content marketing” approach, but one can look at Avvo’s success in the legal market to gain a better idea of how content marketing helps consumers evaluate legal professionals.

Platform for Physician Blogs 

Physician created online content isn’t a new phenomenon. Leading edge physicians like Dr. Val Jones (DrVal) and Kevin Pho, MD (KevinMD) have been blogging for years and have leveraged their content on social media networks, too. (DrVal has over 4,700 followers on Twitter and KevinMD has over 27,000.) With their own content as anchors, they have built physician blogging networks, GetBetterHealth.com and KevinMD.com , respectively. The blogging networks have become destination sites in their own rite and are even attracting content partners who want to reach the audience that these entrepreneurial doctors have attracted. Just a couple of weeks ago, Harvard Health Publications announced an agreement with the Better Health blog to contribute content to GetBetterHealth.com.

With Aggregated Sites, Size Matters

With aggregators, bigger is better when it comes to findability and search engine optimization (SEO). Avvo excels at SEO and if it succeeds in building a large collection of credible health information, it will create a sort of virtuous circle for contributing doctors: they earn trust based on the good content they write, and over time, content from highly rated doctors gains more credibility. One downside of the content marketing approach to building exposure and credibility: not all good doctors are also good writers. For doctors who prefer to focus on other activities (including seeing patients face-to-face), Avvo could still serve as a platform for recommending content from other doctors or information sources. I’m not sure if this content mediation aspect is already incorporated into the Avvo model (I’ll ask them to respond), but I like the idea. We know from Pew Research that when seeking health information or assistance with medical issues more consumers turn to a health professional than to other sources such as family or the internet, so it follows that content recommended online by one’s physician or another credentialed health professional whose qualifications are readily available would be considered trustworthy by most consumers.

Overall, I see a lot of value in Avvo’s model of providing an aggregated platform for doctors to communicate health information to consumers. By offering SEO and content management services, Avvo relieves the physicians of the need to keep current with web technology and search marketing. Better yet, the content marketing approach provides a ’social media’ aspect that allows consumers to get a more complete picture of a physician than can be gleaned from static profile data. And, for those of you who are asking, “so what’s the business model”? , Avvo relies on contextual advertising and sponsored links, à la Google. By providing healthcare information from trustworthy sources (relevance) and broad coverage of healthcare professionals (size), Avvo clearly understands what it takes to succeed when contextual advertising is the sole revenue model.
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 [1]InfoCommerce Group is the parent company of Health Content Advisors.
 [2]See: http://infocommerce.typepad.com/my-blog/2010/11/buying-and-selling-40.html
 [3]http://avvoblog.com/2010/11/01/avvo-launches-doctors/
 [4]KevinMD is now part of the MedPage Today network of health information sites.
 [5]http://getbetterhealth.com/the-better-health-blog-partners-with-harvard-health-publications/2010.11.11.
 [6]86% of the consumers surveyed by Pew Internet said that they ask a health professional, such as a doctor, when they need information or assistance in dealing with a health or medical issue. See: http://www.pewinternet.org/Reports/2009/8-The-Social-Life-of-Health-Information/02-A-Shifting-Landscape/3-The-internet-does-not-replace-health-professionals.aspx for more information.